Getting to know our local health-care facilities and culture in,
sometimes, a tumbling/turmoil way
[
Note: The term
crazygirl
may seem disrespectful, but it’s used with a particular purpose amid more
ambiguity-respecting, and good-faith, considerations.
Edits 7/14/14. Edit 8/6/14: a "sequel" to this entry is viewable here.]
I may have seemed incommunicado in this space lately, but I
have no shortage of blog pieces, for both blogs, that I’m working on. And
actually, amid all else going on last week—summer swelter (with, for me, the
humid air making breathing and sweating not
the best), freelance work, etc.—suddenly my mother had to go to the
emergency room, on Wednesday, which ER was at the Newton Medical Center,
formerly Newton Memorial Hospital. This was the first time she’d ever been
there in this capacity.
I originally wanted to write on the whole experience, which
ran until Friday (she was an inpatient about a day and a half)—first in order
just to put it all in perspective for myself, and then to somehow (as seemed appropriate,
if it did) fashion it for a blog
entry, with specific ethical points made. But I held off, out of a mix of “fatigue”
and discretion…but one particular aspect of this experience stood out as worthy
of blog treatment.
The aspect had to do with a “crazygirl” who was present at
the ER.
Background:
Last Tuesday, as soon as I got home from my work outing for
that day, my mother had wanted to be driven down to the A&P in town to pick
up enemas (not a typical request of
hers). She was stopped up, so to speak, but this was an unusual experience; she
had pain and/or other ill feeling. She had something of an acute crisis. Her
not feeling well not only made her “raring to go” just as I got back—with a quick
break for me to eat a salad she’d made me, so I had something for dinner—but it
left her requiring me to drive, because that’s how out of sorts she felt. She
had felt so unwell, she didn’t even want to eat dinner herself. So I took her
down to the A&P, and she got what she wanted to pick up (not just the
enemas, but other items, including meds from the in-store pharmacy), and we
were back home.
Next day, Wednesday, in the morning, preparing for a normal
day for myself, I played things by ear: How did she feel? Did she feel more
like eating normally? Etc. As it turned out, she would not do her weekly
shopping at a Franklin Borough supermarket as she usually did on a Wednesday,
so she was definitely, still, out of sorts.
Adjusting my own schedule to her schedule change, this past
Wednesday, as was atypical of my
weekly schedules, was one that I had a long day on the road, with a lot of work
gotten done at one library. It was a day to “make hay while the sun shone.” I
didn’t anticipate a crisis when I got home just about the time dinner would
have been ready, about 5 p.m. But—quite unexpectedly for me—now she felt bad
enough, she wanted to go to the acute care facility in Vernon Township, a new
place that had opened not long ago at the location of what had once been called
Great Gorge South (the latter is still a solid part of the skiing complex in the
valley). This new acute care place replaced an acute care facility that had been
further north on Route 94.
She couldn’t eat, was still constipated, had pains in her
lower abdomen…. So I drove her to the acute care place.
First stop: the acute
care place
The New York Times
just had an article last week on a developing economic area of a new
medical-facility gold rush: acute care facilities (of a stand-alone sort),
which are exempt from some of the laws imposed on ERs (which latter require all to be served, even Medicaid hobos,
like me), and now regarded as a promising avenue for Wall Street investors. “Make dollar, make dollar!,” you know. Leave
that general stuff aside (and anyway, I don’t know how relevant the gold-rush
trend is to the particular place we went to…). [Added 7/14/14: In case confusion of terms and concepts occurs, the Times article I referred to was in the July 10 issue, starting on the front page; it references, among other things, "one of the fastest-growing segments of American health care: urgent care, a common category of walk-in clinics with uncommon interest from Wall Street." Today, an article appeared on the Times Web site heralding the opening of a stand-alone "emergency room" at the site of the former St. Vincent's hospital in Greenwich Village; the article makes the distinction between acute-care facilities, which it alleges provide certain types of care at relatively low cost, and stand-alone emergency rooms such as that focused on in the article, which can provide a portal to inpatient care at an affiliated hospital (where, common assumptions would suggest, care isn't discounted).]
Well, very long story short, we spent maybe an hour and a
half, maybe longer there. After a make-or-break computerized processing of her
insurance info was made, she got looked at by a doctor she had never met before.
(This was while her usual “primary,” located in his solo-practitioner office in
the building where the older acute care facility used to be, wasn’t someone she
could easily see in these circumstances, as a simple practical matter. But as
it would turn out, the facilities that would deal with her in the several-day whirlwind
of care that started this day would fax or electronically send all, or the most
key, of the records on it to him.) The determination was made that Wednesday
evening to have her go to the ER at Newton Medical Center. She could get a CT
(CAT) scan right away, she was told. The requisition from the doc she’d seen was
faxed over. So, back on the road.
To the ER
Now the real fun began. (Note: This is not a grump
about alleged substandard practice at the hospital. For all I know, it fit
within all applicable standards. But this didn’t make it all an access of joy.)
We got to the ER at about 7:40 (it takes about 35-40 minutes
to get from home to the Newton hospital, and from the Great Gorge site, it probably
took about 25 minutes). Then we waited and waited in the waiting room…and
finally (well after 9 p.m., I believe) she was brought in to a bed when it
became available. And then we waited there even longer (I sitting near her like
an ever-patient aide). Blood was taken…and even, after a while, a chest X-ray
was taken! For the eventual CT, she was given contrast to drink (not barium).
She wasn’t taken in to the CT room until after midnight. We
were told results would come “soon.” “Soon” turned out to be after about 1:20 a.m.
When a doctor finally told her she would be admitted as an inpatient, I decided
to leave; I felt I was no longer needed. I got home maybe 2:15 a.m. I got less
than four hours of sleep that night. The one saving grace about driving home
that late is that, on Route 94 from Newton to Vernon—which during an average
day can be tedious, with slow pokes and balky trucks “hanging you up”—you can
keep moving (especially with streetlights in your favor) the entire way, even
if your brain seems half-melted from tiredness. A few deer were in random
locations on the roadside, picked out by headlights in the damp summer night,
but no real danger.
##
Well, this just starts the story of the several-day odyssey,
which was most grueling for my mother. But my real focus here was meant to be
the “crazygirl.”
Shortly after we got into the ER—and, you know, by and
large, the random collection of people there were not, I would safely say, a
bunch of feckless layabouts who habitually chose the ER over normal, insured
medical care and therefore drove up the costs for everyone, as was one reigning
canard during the media cheerleading in 2013 for the ACA—a young woman was
waiting in the spacious ER waiting room, pacing about. She had an outfit that
looked like surgical scrubs, worn over more “civilian” clothing. I
hypothesized/assumed she was a nurse, either coming on duty or going off. But
even for a nurse, she had (to my mind) a rather boorish manner.
At one point she spoke to a man who was in vivid pain (who
was moving about haltingly, tenderly, and clutching one side of his abdomen), about
whose apparent problem she said he had “appendicitis.” And she gave ostensibly
encouraging words about what he was doing, as if his expressing the pain was
helping him. By this set of advice (and not hearing quite all of it), I thought
all the more she was quite possibly a nurse.
She hung around, paced here and there. She disappeared
around corners (as if she knew her business there), came back. Before too long,
her not being a nurse became more
evident. Was she a patient? Waiting to get in to a bed? If so, why the surgical
scrubs?
The mysterious girl
asks a bizarre question
At one point she was standing near us, and she had taken off
her surgical-scrubs top, revealing some rather ratty summertime halter top or
the like, with her surgical-scrubs pants still on. She accidentally dropped the
scrubs top on the floor. When she was standing near myself and my mother—and the
two of us had, by now, grown weary with the extremely long wait already—I said
to the young woman, “Miss? You dropped that—” and pointed to the top crumpled
on the floor.
She uttered something like thanks, then picked up the item
of clothing. And pretty soon she faced us, and asked a question that, for a
moment, I wondered whether I really heard: “Do you guys like speed?” I watched
her a brief moment and, opting to nip a potential problem in the bud, said
confidently, “No.” As if to say, ‘I don’t quite know what you are meaning, but
our answer is No.’
At some point in this, my mother gave me a puzzling look or
such. She was much less apt to address the young woman at any point in the
latter’s rambling presence in the waiting room.
A day or so later, when my mother and I talked about this
exchange, and by that time we had concluded the young woman was mentally ill, I
said that with her puzzling question, she seemed to ask us if we “liked” or “‘did,’
and hence liked,” speed in the sense of uppers, or amphetamines. (My mother
said she hadn’t heard her—i.e., made out what she said, though she knew she
addressed us.) I said it was typical of druggie types—she knew this concept pretty
well, if not all its implications—to broach that sort of topic that way, as if
to see if you were “cool,” as the old 1970s concept was (for a “Can you relate
to me?” litmus test). What, in this case, took this craziness “to the next
level” was the young woman’s asking this in a public place, and especially (apparently)
thinking that my mother, who must have looked over 70, would do speed. That is,
the lack of common sense was quite big.
Final disposition of
the crazygirl
Well, back to the ER scene, pre-postmortem. The young woman eventually spent a lot of time
talking to a young man well on the other side of the big waiting room from my
mother and myself, and not all of her words were clear to me, though there was
something that struck me as importunate and a little weird about her manner of talking.
The young man she was talking to would turn out to be a
sober-minded-enough sort who—after the young woman had left the ER entirely—would
eventually go in (as invited) to the bed area of the ER, as a genuine patient. But
before this, at one point, with the young woman still in importunate-talking
mode, another young man headed out
the entrance/exit doors, and gestured with a circling finger near his ear, directed
to the first young man (and out of sight of the young woman) as to say
confidently, “She’s cuckoo!”
At another point, in her rambling talk to the waiting young
man, she made reference to having been considered to have something wrong in
her head, in the way of someone psychologically ill who gives some hint about
such without being fully conscious of this, and without accordingly being considerate
of her position in the ongoing context. (This analyzes and infers hopefully not
too much beyond what there was to witness that night as she talked.) [Added 7/14/14: She took the step of looking more like an oddball when she picked up one of the surgical-type masks, which were in a dispenser for any comers to the ER to use if they feared infection--and no one else there when we were there was using one--and she started wearing it. So, with her somewhat frumpy surgical scrubs, her slightly dysphoric eyes, and her odd way of talking, she gave more of an immediate clue that she was an off-putting eccentric once she had that surgical mask on.]
##
Finally, after about an hour or so of the young woman being
in that room, by this point with her clearly giving no evidence of being
someone who worked there—nor being someone seeking medical treatment as is
usually done in an ER—a couple of the workers there took action. It hadn’t
taken a specific complaint from anyone, I believe. They just took until then to
do something.
A woman from in back—a sort of supervisor, I assumed—and a
security guard, whom I’d earlier seen passing through, looking at the young
woman with a confident eye as if he knew full well what kind of recognizable quantity
she was, and as if she’d been there before—both went with her outside, and
apparently gave her a decisive talking-to. Before long, an SUV appeared outside
the ER’s entry doors, and the young woman got into it and headed off, as if
having requested of significant others (by phone) to be taken home, a little
chastened.
Our suffering the
less-than-healthy
I don’t think I need to draw too many conclusions here—and anyway,
there is enough sheer phenomena going on within the territory of the massive
U.S. health-care “system” where we all can see “new wondrous sights and new causes
for pause”—but one point can be made this way. When I talked with my mother
about this young woman a day or so later—and I generalized in relation to the
people I typically had dealt with in the support-group milieu at the Newton
hospital a decade or more before—I said that other such people (of this woman’s
gender and age) were not hard to deal with, as suffering some kind of psych
disorder—mainly because they knew
they had such a disorder, as their being in the support-group milieu directly
implied. This woman, however, didn’t
seem to have full understanding of being psychologically ill, with the net
result of her being something of a pest in the ER to other people (least
helpfully, to waiting patients).
Even so, this particular woman hadn’t bothered me that much; she was somewhat drolly
amusing. But my mother seemed to regard her askance (in memory and in the
abstract, as well as she had in the concrete at the time) in a rather tough,
uncomprehending way.
(As to whether I would be inclined to get involved in the psych
support-group culture in the county again: no.
Did my part in that already, with the positives coming from the graces of
constructive fellow patients. There are others today who can help out that
situation.)
I don’t know if this makes more-severe value judgments about
the phenomena than are justified. But anyway, this crazygirl stuff was one part
of our several-day hospital involvement, but it was the most spicy and
moral-question-raising.
